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Calcium gluconate
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<h2 id="production">Production</h2> <p>Calcium gluconate is produced commercially through three main methods. These three methods are: chemical oxidation of glucose with a <a href="/facts/Hypochlorite/XMJdjAEM">hypochlorite</a> solution, electrolytic oxidation of a glucose solution containing a known value of <a href="/facts/Bromide/bHSfxGk1">bromide</a>, and a <a href="/facts/Fermentation/rxaDr28b">fermentation</a> process where specific <a href="/facts/Microorganism/pysJYcE2">microorganisms</a> are grown in a medium containing glucose and various other ingredients.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> </p> <h2 id="medical-uses">Medical uses</h2> <h3>Low blood calcium</h3> <p>10% calcium gluconate solution (given <a href="/facts/Intravenously/AwwuD3Nu">intravenously</a>) is the form of calcium most widely used in the treatment of <a href="/facts/Hypocalcemia/HnwyWCL2">low blood calcium</a>. This form of calcium is not as well absorbed as <a href="/facts/Calcium_lactate/oDPwyaIj">calcium lactate</a>,<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> and it only contains 0.93% (93 mg/dL) calcium ion (defined by 1 g weight solute in 100 mL of solution to make 1% solution <a href="/facts/W/v/FfIuxa7T">w/v</a>). Therefore, if the hypocalcemia is acute and severe, <a href="/facts/Calcium_chloride/e1EwNPGF">calcium chloride</a> is given instead. </p> <h3>High blood potassium</h3> <p>Calcium gluconate is used as a cardioprotective agent in people with <a href="/facts/Hyperkalemia/epfvUg5w">high blood potassium levels</a>, with one alternative being the use of calcium chloride.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> It is recommended when the potassium levels are high (>6.5 mmol/L) or when the <a href="/facts/Electrocardiogram/YpVswJ0W">electrocardiogram</a> (ECG) shows changes due to high blood potassium.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> </p><p>Though it does not have an effect on potassium levels in the blood, it reduces the excitability of <a href="/facts/Cardiomyocytes/fE40oTQz">cardiomyocytes</a>, thereby lowering the likelihood of <a href="/facts/Cardiac_arrhythmias/ooEpr46Q">cardiac arrhythmias</a>.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> </p> <h3>Magnesium sulfate overdose</h3> <p>It is also used to counteract an overdose of Epsom salts <a href="/facts/Magnesium_sulfate/o3GwKEoQ">magnesium sulfate</a>,<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> which is often administered to pregnant women in order to prophylactically prevent seizures (as in a patient experiencing <a href="/facts/Preeclampsia/FG1BrbC8">preeclampsia</a>). Magnesium sulfate is no longer given to pregnant women who are experiencing <a href="/facts/Premature_labor/szMos8tu">premature labor</a> in order to slow or stop their contractions (other <a href="/facts/Tocolytic/eGlSbTTq">tocolytics</a> are now used instead due to better efficacy and side effect profiles). Excess magnesium sulfate results in magnesium sulfate toxicity, which results in both <a href="/facts/Respiratory_depression/ruqIr4oa">respiratory depression</a> and a loss of <a href="/facts/Deep_tendon_reflex/236Ip0pF">deep tendon reflexes</a> (<a href="/facts/Hyporeflexia/2FKMaHBd">hyporeflexia</a>). </p> <h3>Hydrofluoric acid burns</h3> <p class="note">Main article: <a href="/facts/Hydrofluoric_acid_burn/b5sIYMTo">Hydrofluoric acid burn</a></p> <p><a href="/facts/Gel/gBFE0s9G">Gel</a> preparations of calcium gluconate are used to treat <a href="/facts/Hydrofluoric_acid/wdXqu4bE">hydrofluoric acid</a> burns.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a><a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> The calcium gluconate reacts with hydrofluoric acid to form insoluble, non-toxic <a href="/facts/Calcium_fluoride/fCKHAvp1">calcium fluoride</a>. In addition to a 2.5% calcium gluconate gel being applied directly to the <a href="/facts/Chemical_burn/GycBJMJo">chemical burn</a>, the person may also receive calcium gluconate supplements because the fluoride ion precipitates <a href="/facts/Serum_calcium/wgUxKej5">serum calcium</a>, causing <a href="/facts/Hypocalcaemia/HnwyWCL2">hypocalcemia</a>.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> </p> <h3>Cardiac arrest</h3> <p>While intravenous calcium has been used in <a href="/facts/Cardiac_arrest/HIAm9AWX">cardiac arrest</a>, its general use is not recommended.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> Cases of cardiac arrest in which it is still recommended include <a href="/facts/High_blood_potassium/epfvUg5w">high blood potassium</a>, <a href="/facts/Low_blood_calcium/HnwyWCL2">low blood calcium</a> such as may occur following <a href="/facts/Blood_transfusions/fb0Mk6Dx">blood transfusions</a>, and <a href="/facts/Calcium_channel_blocker_overdose/c3wneeKd">calcium channel blocker overdose</a>.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> There is the potential that general use could worsen outcomes.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> If calcium is used, calcium chloride is generally the recommended form.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> </p> <h2 id="side-effects">Side effects</h2> <p>Calcium gluconate side effects include <a href="/facts/Nausea/dyhkcbeD">nausea</a>, <a href="/facts/Constipation/l4DHHM6L">constipation</a>, and <a href="/facts/Upset_stomach/aF6gPB0G">upset stomach</a>. Rapid intravenous injections of calcium gluconate may cause <a href="/facts/Hypercalcemia/kdEeLaVd">hypercalcemia</a>, which can result in <a href="/facts/Vasodilation/cjzrU8Ro">vasodilation</a>, <a href="/facts/Cardiac_arrhythmias/ooEpr46Q">cardiac arrhythmias</a>, decreased <a href="/facts/Blood_pressure/VtqqSM2J">blood pressure</a>, and <a href="/facts/Bradycardia/70msP5HD">bradycardia</a>. <a href="/facts/Extravasation_(intravenous)/Xtado9tX">Extravasation</a> of calcium gluconate can lead to cellulitis. Intramuscular injections may lead to local <a href="/facts/Necrosis/zCPsTeWx">necrosis</a> and abscess formation.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> </p><p>It is also reported that this form of calcium increases <a href="/facts/Renal_blood_flow/IyK7n7j7">renal plasma flow</a>, <a href="/facts/Diuresis/oWIcAEcN">urine production</a>, <a href="/facts/Natriuresis/FbQy3VXJ">sodium excretion</a>,<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> <a href="/facts/Glomerular_filtration_rate/kJKJge0o">glomerular filtration rate</a>,<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> and <a href="/facts/Prostaglandin_E2/Ea6qXhDL">prostaglandin E2</a> and F1-alpha levels.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> </p> <h2 id="society-and-culture">Society and culture</h2> <ul><li>Shortages of medical calcium gluconate were reported in November 2012 and November 2015 in the United States.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a></li> <li>Historically, intravenous calcium gluconate was used as an antidote for <a href="/facts/Latrodectus/EvakNUEQ">black widow spider envenomation</a>, often in conjunction with <a href="/facts/Muscle_relaxant/9jtlSa90">muscle relaxants</a>.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> This therapy, however, has since been shown to be ineffective.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a></li></ul> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Calcium_lactate_gluconate/dTVmS4Fm">Calcium lactate gluconate</a></li> <li><a href="/facts/Calcium_citrate/CCklQEor">Calcium citrate</a></li> <li><a href="/facts/Dicalcium_phosphate/0e5ek9b5">Dicalcium phosphate</a></li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="https://druginfo.nlm.nih.gov/drugportal/name/calcium%20gluconate">"Calcium gluconate"</a>. <i>Drug Information Portal</i>. U.S. National Library of Medicine.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Calcium Salts". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/calcium-salts.html" target="_blank">https://www.drugs.com/monograph/calcium-salts.html</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Calcium Salts". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/calcium-salts.html" target="_blank">https://www.drugs.com/monograph/calcium-salts.html</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 680, 694. ISBN 9780857111562. <a href="9780857111562" target="_blank">9780857111562</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 497. hdl:10665/44053. ISBN 9789241547659. <a href="9789241547659" target="_blank">9789241547659</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Calcium Salts". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/calcium-salts.html" target="_blank">https://www.drugs.com/monograph/calcium-salts.html</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>"Calcium Salts". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. 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